Initial Management and Damage Control Priorities

The initial management and prioritization of treatment for orthopedic combat trauma casualties embraces a multidisciplinary approach with damage control principles that focus on saving life and limb. The current echelons of care established within the downrange combat environment facilitate advancing patient stabilization along with expedited transfer out of theater. This system works to minimize the constraints of operating on complex injuries in an austere setting with limited resources. Deploying surgeons must understand and accept that definitive care for US and coalition casualties occurs out of the hostile combat region. Nevertheless, the most critical decisions pertaining to the salvage of life and limb begin with initial downrange care. Improper or hasty decision-making made by surgeons unfamiliar with combat orthopedic trauma care can lead to irreparable outcomes for wounded warriors that may affect their overall morbidity and mortality. Therefore, the deployed orthopedic surgeon should have an established knowledge of damage control priorities, the current military clinical practice guidelines (CPGs), and an understanding for musculoskeletal treatment pathways specific to combat blast injuries and wounding patterns.